title: Identifying patients at risk for obstructive sleep apnea in a primary care practice.
abstract: OBJECTIVE
  The purpose of this study was to determine ((1)) whether our review of systems (ROS) form facilitates identification of sleep complaints; ((2)) how frequently department physicians investigate these sleep complaints; ((3)) the prevalence of our family practice patients at increased risk for obstructive sleep apnea (OSA); and ((4)) how well ROS responses function as diagnostic tests to identify OSA risk.
  
  
  METHODS
  We used a prospectively collected sample of consecutive adult patients undergoing preventive examinations at 2 family medicine clinics. Patients completed ROS forms and the Berlin Questionnaire to determine OSA risk level. Physicians at only one site used ROS forms during care.
  
  
  RESULTS
  Two hundred forty-nine of 382 eligible patients (65%) completed forms and underwent examinations. Thirty-seven percent responded positively to sleep-related ROS questions. Physicians documented 24% of those complaints. ROS form use affected documentation (31% with use vs 5% without; P = .03). Thirty-three percent of all patients had increased OSA risk. Fifty-seven percent of high-risk patients responded affirmatively to an ROS question as opposed to 27% for those at lower risk (P < .001). ROS responses were 57% sensitive and 73% specific for increased OSA risk.
  
  
  CONCLUSIONS
  Sleep symptoms were common and were recognized significantly more often when our physicians used a ROS form. However, few complaints were investigated. Our current ROS sleep questions are not sufficiently sensitive to identify increased OSA risk. Physicians should prioritize evaluation of sleep dysfunction because of the association with OSA.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA. grover.michael@mayo.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Grover
authors.forename: Martina
authors.initials: M
authors.lastname: Mookadam
authors.forename: Danielle
authors.initials: D
authors.lastname: Armas
authors.forename: Ciara
authors.initials: C
authors.lastname: Bozarth
authors.forename: Tarah
authors.initials: T
authors.lastname: Castleberry
authors.forename: Meghan
authors.initials: M
authors.lastname: Gannon
authors.forename: Denise
authors.initials: D
authors.lastname: Webb
authors.forename: Amylou
authors.initials: A
authors.lastname: Dueck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult